ROANOKE, Va. — I have listened carefully over the years to speakers from the American Reusable Textile Association (ARTA) and various linen companies discuss the barrier classification system. I have heard respected industry experts like Brad Bushman of Standard Textile explain that their products must start significantly over the required barrier level so that the product will still exceed the minimum set by the standard by the time it gets to the end of its recommended life.
What they will not say directly is that the reusable barrier surgical linen (non-impervious) will lose some barrier effectiveness with every washing. It does not matter what manufacturer you buy from or what chemical company you use. All reusable barrier surgical linen will lose barrier effectiveness with each processing.
If the reusable barrier surgical linen is improperly processed with excessive amounts of alkali and high temperature (normally used to remove oil stains), the barrier level will quickly drop to unacceptable levels, I’ve discovered.
Unfortunately, the barrier on the polyester panels is gradually removed during each processing. If the product is washed in an aggressive wash formula, the barrier on the polyester panels can be significantly compromised in as few as 10 washings. Once this barrier is compromised, mineral oils and fats readily stain an operating gown during surgery. Once stained with oil, the product is no longer accepted for use in the operating room.
Given the price of this new-generation reusable surgical linen, it is imperative, from a cost standpoint, that each piece of linen stays in the system for as many processes as possible. Barrier efficiency, staining and holes are the three major quality concerns with these products.
I started using a washer-applied barrier retreatment product back in 1997. This product is added to the last step in the wash formula. Over the years, I have been surprised by how poorly this product has been accepted in the laundry market. I realize that the price for this product is high, but I believe that if the case for its use was properly laid out, everyone would use it.
Does a barrier retreatment product really work? It depends on the nature of the product you are using. There are basically three types of products on the market: wax-based, fluoropolymer-based, and a mixture of the two. I personally do not favor the use of any product that contains wax. The fluoropolymer adheres to the fibers only and, therefore, does not have an effect on the air permeability of the fabric. Also, it will not cause yellowing.
We conducted extensive Suter hydrostatic tests on reusable barrier linen, trying to determine the optimum wash formula. Our goal was to limit the amount of barrier loss on the fabrics while maintaining an acceptable rewash level. After a year of testing, we started using a barrier retreatment product and continued with our regular barrier-testing program. We conclusively proved that the barrier retreatment product eliminated the loss of barrier.
In the case of barrier operating room wrappers and barrier isolation gowns, we actually saw an increase in their barrier properties from when they were new. We tested barrier isolation gowns that had been processed more than 100 times, and the barrier on the gown was better than the day it came out of the box. We also tracked our rewash and found that our rates went down at the same time.
The Gore-Tex® surgeon gown, at first glance, would appear to be an item that does not need a barrier retreatment product. The barrier is created by a thin piece of Teflon™ sandwiched between two layers of 100% polyester fiber. The fiber is treated with a water-repellent product during manufacturing. Why would the maker treat the polyester with a barrier treatment when the barrier nature of the gown is based on the Teflon™ in the middle layer? The reason is that polyester fibers love oil.
As I mentioned earlier, the barrier on the polyester panels is gradually removed during each process and can be significantly compromised in as few as 10 washings.
What is the cost of having to retire a $75 gown early versus using a barrier retreatment product? If the gown is expected to get 75 uses during its life, the product cost per use is $1 per use. The cost of using a barrier retreatment program is about 5 cents per use. This would raise the per-use product cost to $1.05.
If, however, the gown becomes unusable after, say, 50 uses, the actual product cost is $1.50 per use. If you are using an aggressive wash formula and only get 25 uses before it becomes stained, then the cost is $3 per use. Based on my math, the break-even point on using the product is set at four additional uses of the gown.
It is clear that the cost of using a barrier retreatment product on new-generation reusable barrier linen can quickly be covered by the extended life of the garments. It also provides a quality assurance program that will be appreciated by your end-users.